The ability of single site, single depth sacral lateral branch blocks to anesthetize the sacroiliac joint complex.
OBJECTIVE
To determine the physiologic effectiveness of single site, single depth sacral lateral branch injections.


METHODS
Randomized, controlled, and double-blinded study.


METHODS
Outpatient pain management center.


METHODS
Fifteen asymptomatic volunteers.


METHODS
The dorsal sacroiliac ligament was probed and the sacroiliac joint was injected with contrast medium until capsular distension occurred. The presence or absence of pain with each maneuver was noted. Under double-blind conditions, subjects returned 1 week later for L5 dorsal ramus and S1-4 lateral branch injections; 10 subjects received 4% lidocaine (active) injections while five subjects received saline (control) injections. After 30 minutes, subjects had repeat ligamentous probing and capsular distension of the same sacroiliac joint that was previously tested. The presence or absence of pain with each maneuver was noted. In a parallel anatomic study, S1 and S2 lateral branch injections with green dye were performed on two nonembalmed cadavers. Dissection was undertaken to quantify the degree of staining of these target lateral branch nerves.


METHODS
Presence or absence of pain for ligamentous probing and sacroiliac joint capsular distension.


RESULTS
Forty percent had no discomfort upon repeat ligamentous probing after active lateral branch injections while 100% retained pain upon repeat ligamentous probing with control lateral branch injections. Forty percent of the active group and 20% of the control group did not feel repeat capsular distension of the sacroiliac joint after the lateral branch injections. In the anatomic study, 11 lateral branch nerves were isolated while staining occurred in only four cases or 36%.


CONCLUSIONS
Anatomic limitations exist with single site, single depth sacral lateral branch injections rendering them physiologically ineffective on a consistent basis.
Dreyfuss
Paul
P
Washington Interventional Spine Associates, Bellevue, Washington, USA. pauldreyfuss@gmail.com
Snyder
Benjamin D
BD
Park
Kathryn
K
Willard
Frank
F
Carreiro
Jane
J
Bogduk
Nikolai
N
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D017288:Pain Threshold / Q000187:drug effects*; D012446:Sacroiliac Joint / Q000187:drug effects*; D055815:Young Adult
D000779:Anesthetics, Local; D008012:Lidocaine